Provider Demographics
NPI:1932411378
Name:BALL, LETICIA (MA)
Entity type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3537
Mailing Address - Country:US
Mailing Address - Phone:559-289-5745
Mailing Address - Fax:
Practice Address - Street 1:1776 AVENUE D
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-2658
Practice Address - Country:US
Practice Address - Phone:559-289-5745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47718106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist